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Image-Guided Ablation of Renal Tumours

Image-Guided Ablation of Renal Tumours - What it is

​The kidneys are bean-shaped organs located on each side of the mid back, just below the rib cage.  They filter the blood, and remove excess water and waste in the urine.  The most common form of kidney cancer in adults is renal cell carcinoma (80-85%). 

Image-Guided Ablation of Renal Tumours - Symptoms

Renal cell carcinoma usually does not cause obvious symptoms, especially in the early stages, and are discovered by chance.  When symptoms do occur, the common ones include:
  • Blood in urine (haematuria)
  • Pain in the sides of the mid back (loin)
  • Mass (lump) in the loin
  • Weight loss, loss of appetite, night sweats and/or unexplained fever

Image-Guided Ablation of Renal Tumours - How to prevent?

​There are no known measures to prevent the development of renal cell carcinoma.  However, a small, early stage renal tumour may benefit from early intervention which can potentially be curative.

Image-Guided Ablation of Renal Tumours - Causes and Risk Factors

While the exact cause of renal cell carcinoma is unknown, there are known risk factors that may increase your chance of developing cancer:
  • Old age and male gender
  • Hereditary conditions such as von Hippel-Lindau disease and hereditary papillary renal cell carcinoma
  • Underlying horseshoe kidneys, polycystic kidney disease
  • Family history of renal cancer
  • Smoking
  • Obesity
  • High blood pressure
  • Advanced kidney disease
  • Occupational exposure to certain substances such as cadmium (a type of metal), some herbicides and organic solvents 

Image-Guided Ablation of Renal Tumours - Diagnosis

Laboratory tests can sometimes give the first hint that there may be a kidney problem but kidney cancers are generally diagnosed on imaging and biopsy.  

Types of imaging tests include ultrasound (US), computer tomography (CT) or magnetic resonance imaging (MRI).

Biopsy can be performed either via a needle under image guidance or during surgery when the whole tumour is removed.

Image-Guided Ablation of Renal Tumours - Treatments

Stage 1 renal cell carcinoma which has not spread beyond the kidney is usually surgically resected by removing part or all of the kidney (partial or radical nephrectomy).

Depending on the tumour size, minimally invasive ablation therapy is an alternative treatment especially if you are not an ideal surgical candidate.  Ablation techniques include burning (radiofrequency and microwave ablation) or freezing (cryoablation) to extreme temperatures.  This procedure is usually well tolerated, and performed under sedation or general anaesthesia.   It involves insertion of a ablation needle through a small skin incision into the tumour lesion under imaging (US or CT) guidance.  Ablation causes irreversible destruction of the tumour cells.  At the end of the procedure, the needle is removed and a scan performed to ensure no immediate complications. 

You should discuss with your care team the best treatment option for your case. 

Image-Guided Ablation of Renal Tumours - Preparing for surgery

Before renal tumour ablation, we will perform a clinical assessment which includes reviewing your medical history, blood tests (clotting times, renal function and blood count) and imaging test.  
Biopsy is usually performed prior to treatment.  

If you are on any blood-thinning medications (antiplatelet and/or anticoagulant), you will be advised on the appropriate timing to stop them.  On the day of the procedure, you will be fasted for 6 hours prior to the time of the planned procedure. 

Image-Guided Ablation of Renal Tumours - Post-surgery care

After the ablation, a small dressing will be applied over the needle puncture site.  You will be monitored overnight in the ward, and may be discharged in 1-2 days if you remain well.  

You may experience loin pain/ ache, discomfort and/or bruising, which should resolve in a few days.  You will be able to eat and drink after recovering from anaesthetic effect and as tolerated.  Most patients can resume normal daily activities within a few days.  

Medical attention should be sought if you have persistent abdominal pain, distension, giddiness and/or haematuria.  An outpatient appointment will be given to you to be reviewed in the Interventional Radiology clinic.  A CT scan is usually performed in about 3 months to assess the adequacy of the ablation.

Renal Ablation
A Chinese man in his 70s with an incidental 2.3cm left renal cell carcinoma detected on CT (arrows).  He underwent renal ablation as he was not an ideal surgical candidate. 

Renal Ablation
Under US visualisation, the ablation needle is advanced into the renal lesion (arrow). 

Image-Guided Ablation of Renal Tumours - Other Information

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